Hospitals Re-Think Neurological Services to Meet Geriatric Needs

This article appears in the March 2013 issue of HealthLeaders magazine.

Six years ago, the 1,239-bed Cleveland Clinic began to systematically take on one of the biggest challenges looming in healthcare: an increasing aging patient population that needs neurological care.

In 2007, the Cleveland Clinic in Ohio had only "a handful of neurologists in our regional hospitals" who treated perhaps 1,000 elderly patients with neurological conditions a year, recalls Stephen Samples, MD, vice chairman of the Cleveland Clinic's Neurological Institute. By 2012, he says that number grew to 38 physicians overseeing the care of 52,000 patients, reflecting the urgently expanding needs in neurological care, especially in geriatric medicine.

At the Cleveland Clinic and other facilities around the country, the burgeoning 65-and-older population is expected to drive up the number of neurological geriatric patients, increasing volumes in hospitals that focus on complex conditions, with subspecialties targeting dementia and other cognitive disorders. Programs aimed at older people with such disorders, or those afflicted with Alzheimer's or Parkinson's disease, are expected to grow dramatically as the country ages.

Some hospitals are ramping up their care planning with specialized clinics in neurological institutes and changing their specialties to meet the demographic needs of their aging communities. In other cases, hospitals are using holistic approaches to care, emphasizing multidisciplinary programs to improve education and rehabilitation programs for patients to address their debilitating conditions.

"We already know that neuroscience has a predominant geriatric flavor," says Samples. "We firmly believe that neurology is not one specialty, but different specialties, like Parkinson's disease, dementia, spinal disease, dizziness, and balance problems. In the next 10 to 15 years, neurological care would be for each disease process, like how there are now different specialties for cardiology care, which was all considered internal medicine years ago."

The need for geriatric care in neurology is blossoming. About 5.4 million people have Alzheimer's disease, and most of that, 5.2 million, represents those 65 and older. The dire consequences of these illnesses give medical centers financial headaches of their own. "We're not making money; we're trying to reduce the cost of care for that patient population," says Deborah Spielman, assistant vice president of Florida Hospital and administrator of the Florida Hospital Neuroscience Institute in Orlando, part of the 2,247-bed Florida Hospital system that has acute care facilities in Orlando, Tampa, and Daytona Beach.

While hospitals must brace for a growing number of patients, reduced reimbursements and shortages of neurologists and geriatric physicians are forcing them to be innovative in their care. That, in turn, is prompting hospitals to initiate changes in their care models to avoid needless or more expensive programs, says Spielman. Focusing on geriatric neurological ailments, the hospital established a Maturing Minds Clinic adjacent to its 120-bed neurological facility in Orlando. There, physicians can evaluate conditions and work toward avoiding hospitalizations of neurological geriatric patients, who can be cared for through alternative programs. "More and more, the adult children are at their wits' end, and we feel it's our obligation to offer comprehensive programs," Spielman says.

Hospitals are refocusing on geriatric neurological conditions to ease the strain on other parts of their operations, such as the emergency department, says Laurie Delgado, president of Cleveland-based 101-bed total UH Regional Hospitals, Bedford and Richmond Medical Center campuses. In that way, the Ohio health system organized a specialized "senior" ED within its main ED to accommodate patients who have dementia or Alzheimer's disease, she says.